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  XVII International AIDS Conference
Mexico City
3-8 August 2008
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Clinicians Fail to Routinely Provide Reproductive Counseling to HIV-Infected Women in the United States
  Reported by Jules Levin
IAC Aug 3-8, 208 Mexico City
Dawn Averitt Bridge,1 Sally Hodder,2 Kathleen Squires,3 Judith Aberg,4 Staats Abrams,5 Stephen P Storfer,6 Judith Feinberg7 1TheWell Project, Atlanta, GA; 2University ofMedicine and Dentistry of New Jersey, Newark, NJ; 3Thomas Jefferson University, Philadelphia, PA; 4New York University, New York, NY; 5GfK Roper Public Affairs &Media, New York, NY; 6Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT; 7University of Cincinnati, Cincinnati, OH
from Jules: are these results surprising? Not really, a number of domestic issues and overall care in the USA are being neglected while we spend $50 billion oversease. ItŐs good to help the global effort but not at the serious expense & neglect of those with HIV here at home. I have been saying this for years. The USA care system is not adfequate in addressing important health concerns. The issue of underfunding HIV in the USA was raised in Mexico City BUT only as it relates to the CDC underreporting new HIV cases by 40% so the issue was raised in the context that prevention is underfunded, and they miss the whole point. There are many very important issues underfunded in particular: good care at clinics & hospitals, doctors are under-reimbursed so they are not incentivized to remain in IV or to give good care, HCV coinfection gets no funding, ADAP needs more funding, the aging HIV population is seriously growing (by 30% in the last few years), bone disease among HIV+ has been totally neglected (65% at the average age of 45 have osteopenia), and prevention and better identifying those who are HIV-infected but donŐt know it are also important.
This survey revealed a communications gap between HIV-positive women and their health care providers concerning discussions relating to pregnancy and family planning.
The results suggest that HIV care providers are missing opportunities to discuss contraception and preconception care, specifically, issues related to specific antiretroviral therapy and its impact on maternal and fetal health.
Over the past 2 decades, there has been a sharp increase in the proportion of women living with HIV/AIDS in the United States. Of the 1.2 million adults and adolescents with HIV/AIDS in the United States, it is estimated that approximately 300,000 are women.1
The majority of women diagnosed with HIV/AIDS in the United States are of childbearing age, with more than 6000 HIV-positive women giving birth each year.2,3
HIV-positive women of childbearing age should be queried on their plans regarding pregnancy, as it may impact their choice of antiretroviral agents and avoidance of teratogenic medications.
The Women Living Positive survey was designed to explore the attitudes and behaviors of HIV-positive women in the United States; it included an assessment of the dialogue between HIV-positive women and their health care providers on pregnancy and family planning issues.
The Women Living Positive survey was a telephone-based survey designed for HIV-positive women who had been receiving antiretroviral therapy for 3 or more years.
Flyers advertising the survey were placed at a national network of AIDS counseling centers in the United States, directing those interested in participating to call an 800 number.
The 15-minute telephone survey consisted of a series of eligibility questions plus 45 questions designed to effectively detail the patientŐs relationship with HIV health care providers, treatment priorities, and general pregnancy and HIV understanding, along with emotional aspects of living with HIV, including gender-specific questions about pregnancy and family planning issues.
The survey was conducted by GfK Roper Public Affairs, a public opinion polling firm, and funded by Boehringer Ingelheim Pharmaceuticals, Inc. The Well Project, a nonprofit organization focusing on women and HIV, had input into survey questions.
Respondents were anonymously interviewed by telephone from December 21, 2006 through March 14, 2007; interviews were conducted in both English and Spanish.
Data were weighted by census regions and ethnicity/race to match the demographic profile of adult HIV-positive women in the United States.
Survey participants were compensated $25 for their time.
Patient demographics

A total of 700 HIV-positive women participated in the survey (42.9% African American, 28.6% Hispanic, and 28.6% Caucasian).
Of the participants, 16% were from the western United States, 21% were from the Midwest, 33% were from the South, and 30% were from the Northeast.
The mean age of the women was 42.5 years; 39% had children.
Participants had lived with HIV for a mean of 10.6 years and were receiving antiretroviral therapy for a mean of 8.1 years.
Discussion of pregnancy and family planning
Of the 700 women interviewed, 31% (62% African American, 25% Hispanic, and 13% Caucasian) reported that they were contemplating pregnancy or had been pregnant in the past but were not currently pregnant. Of these women, 48% were not asked by their HIV provider if they wanted to have a child either now or in the future.
When adding the women who were currently pregnant to this group, 79% said that they would feel comfortable talking to their provider about becoming pregnant and treatment options for pregnancy. This response was consistent across all races/ethnicities (Figure 1).
A smaller proportion of women in the West and Midwest compared with the South and Northeast said that they would feel comfortable talking to their provider about becoming pregnant and what the treatment options were for pregnancy (Figure 2).



Of the women who indicated that they contemplated pregnancy or were currently or previously pregnant, 41% had not discussed with their HIV provider whether their treatment options should change in the event of pregnancy, and 29% said that their provider did not explain the effects that certain HIV medication might have on them and their baby if they were pregnant.
Of the 700 women interviewed, 22% reported that since being diagnosed with HIV, they had been pregnant or were currently pregnant at the time of the interview; 57% of these women did not discuss pregnancy and appropriate HIV treatment options with their HIV provider prior to becoming pregnant.
Also, of these women, 42% indicated that they were not very or not at all aware of the treatment options available to them when they first became pregnant (Figure 3).


1.World Health Organization. Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections. United States of America; 2006 Update. Geneva:World Health Organization; December 2006.
2.Centers for Disease Control and Prevention. Cases of HIV Infection and AIDS in the United States, by Race/Ethnicity, 2000-2004. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2006. HIV/AIDS Surveillance Supplemental Report 2006; 12(No. 1):1-36.
3.Centers for Disease Control and Prevention. Quick Facts: Perinatal April 2003 -March 2005. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; January 2005.